Detoxification therapy of traditional Chinese medicine for genital tract high-risk human papillomavirus infection: A systematic review and meta-analysis.
机构:[1]Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P.R. China,[2]Department of Gynecology, Hospital of Chongqing Institute of Traditional Chinese Medicine, Chongqing, P.R. China,[3]Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, P.R. China,四川大学华西医院[4]Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan , P.R. China
Persistence of high-risk human papillomavirus (hr-HPV) infections is the most critical risk factor for cervical intraepithelial neoplasia (CIN) and cervical cancer (CC). Treatment of persistent oncogenic HPV-positive women after 12-24 months follow-up is still controversy. Detoxification therapy of Chinese medicine (DTCM) has been conducted recently. However, the conclusions are still unclear. We planned to conduct a systematic review and meta-analysis to explore DTCM in the treatment of persistent hr-HPV infections.
Nine electronic databases were systematically searched from their inception to 30 September 2018. Randomized controlled trials comparing DTCM with follow-up or placebo were included. Risk of bias was assessed by the Cochrane 'Risk of Bias' tool. Review Manager 5.3 was used for statistical analyses. Relative ratios (RR) and 95% confidence intervals were used for dichotomous data, and the mean difference (MD) was used for continuous data. We assessed the quality of trials by the GRADE.
Seventeen RCTs from 2011 to 2018 with 1906 participants were included. The evidence showed that DTCM had a pooled efficacy difference in favor of increasing the HPV clearance rate compared to placebo groups (RR = 2.62, 95% CI 1.28 to 5.33, very low quality) and follow-up groups (RR = 1.88, 95% CI 1.60 to 2.22, low quality). The median HPV persistence tended to decline from 50% within six months to 41.5% at 12 months, and 31.5% at 24 months. A significantly increased regression rate of CIN was found in the DTCM compared with placebo groups (RR = 3.61, 95% CI 1.21 to 10.83, very low quality) and follow-up groups (RR = 1.79, 95% CI 1.31 to 2.45, very low quality). Additionally, we found DTCM have an impact on TNF-α (MD = 2.99, 95% CI 1.90 to 4.07; very low quality), IFN-α (MD = 3.47, 95% CI 2.42 to 4.52; very low quality), CD4+/CD8+ cells (MD = 0.21, 95% CI 0.05 to 0.37; very low quality) compared with follow up groups in some trials with small sample sizes. The major adverse events were genital mucosal irritation symptoms (10%, 5/50).
DTCM have favorable outcomes on improving the HPV clearance rate, increasing the regression rate of CIN, and impacting the proportion of some immune cells and cytokine levels. However, most of the evidence was of low quality. Any future high-quality trials and a more extended follow-up period of 24 months or more should be performed.
基金:
This work was supported by grant
81473722 from the National Natural Science
Foundation of China (to SBW), grant 71704120
from the National Natural Science Foundation of
China (to JJY), and grant YYZX20180049 from the
"Xinglin Scholars" Hospital Foundation of Chengdu
University of Traditional Chinese Medicine (to ML).
The funders had no role in study design, data collection and analysis, decision to publish, or
preparation of the manuscript.
语种:
外文
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中科院(CAS)分区:
出版当年[2019]版:
大类|3 区综合性期刊
小类|3 区综合性期刊
最新[2023]版:
大类|3 区综合性期刊
小类|3 区综合性期刊
第一作者:
第一作者机构:[1]Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P.R. China,[2]Department of Gynecology, Hospital of Chongqing Institute of Traditional Chinese Medicine, Chongqing, P.R. China,
通讯作者:
推荐引用方式(GB/T 7714):
Luo Mei,Yu JiaJie,Zhu ShuYi,et al.Detoxification therapy of traditional Chinese medicine for genital tract high-risk human papillomavirus infection: A systematic review and meta-analysis.[J].PloS one.2019,14(3):e0213062.doi:10.1371/journal.pone.0213062.
APA:
Luo Mei,Yu JiaJie,Zhu ShuYi,Huang Li,Chen Yu&Wei ShaoBin.(2019).Detoxification therapy of traditional Chinese medicine for genital tract high-risk human papillomavirus infection: A systematic review and meta-analysis..PloS one,14,(3)
MLA:
Luo Mei,et al."Detoxification therapy of traditional Chinese medicine for genital tract high-risk human papillomavirus infection: A systematic review and meta-analysis.".PloS one 14..3(2019):e0213062